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ftN   IMkiiijUBAL  DISSERTATION 
ON   INSaNITI 


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in  2011  with  funding  from 

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T 


AN 

INAUGURAL  DISSERTATION 


ON 


INSANITY: 


SUBMITTED  TO  THE  PUBLIC  EXAMINATION  OF  THE  TRUSTEES 

OF  THE   COLLEGE  OF  PHYSICIANS  AND  SURGEONS, 

IN  THE  STATE  OF  NEW-YORK, 

SAMUEL  BARD,  M.  D.  President, 

FOR    THE    DEGREE    OF 

DOCTOR    OF    MEDICINE, 

ON'    THE     14TH    DAY    OF    MAY,     1811. 

BY  THEODRIC  ROMEYN  BECK,  A.  M. 

LICENTIATE     IX    MEDICINE    OF     THE     MEDICAL    SOCIETY    OF     THE 
COUNTY    OF    NEW-YORK. 


Canst  (lion  not  minister  to  a  mind  dise&s'd  ; 

I'luck  from  the  memorj  a  rooted  Borrow  ; 

Baze  oat  the  written  trouble*  of  the  brain  ; 

Ami  frith  wiinc  tweet  oblivious  antidote, 

derate  the  foul  bosom  of  thai  perilous  stuff, 

V\  in*  Ij  u'i^lis  upon  the  heart  I  Macbeth 


A'EW-YORK  : 

'  I  I)    !l\    1.  IB1  MOI   II.   M  I.    10,    IOIP,  MHKKI 

1 1. 


J33fs 

/n/ 


TO    THE 

REV.  JOHN  B.  ROMEYN,  D,  D, 

THIS  DISSERTATION 
IS  MOST   SINCERELY  INSCRIBED, 

WITH  ALL  THE  FEELINGS 

THAT  GRATITUDE,  ESTEEM,  AND  THE  HIGHEST  RESPECT 

CAN  INSPIRE, 

BY  HIS  AFFECTIONATE  NEPHEW, 

THE  AUTHOR 


TO 

DAVID  HOSACK,  M.D.  F.L.S. 

PROFESSOR  OF  THE  THEORY  AND  PRACTICE  OF    PHYSIC,    AND 

CLINICAL    MEDICINE, 

IN  THE  COLLEGE  OF  PHYSICIANS  AND  SURGEONS; 

FELLOW  OF  THE    AMERICAN    PHILOSOPHICAL    SOCIETY, 

AND    OF     THE 

COLLEGE    OF  PHYSICIANS  AT   PHILADELPHIA; 

COIBBSFONBING  MEMBER   OF    THE  MEDICAL  SOCIETY    OF 

LONDON,    SCC.  &C. 

AS  AN  ACKNOWLEDGMENT 

FOR    HIS 

MEDICAL  INSTRUCTIONS,  AND  PERSONAL  ATTENTION, 


OBLIGED  PUPIL  AND  FRIEND. 


DRS.  WILLIAM  M'CLELLAND, 

AND 

JAMES  LOW, 

OF    ALBANY, 

THIS  DISSERTATION, 

THE  FIRST  FRUITS  OF  AN  EDUCATION  COMMENCED 
UNDER  THEIR  CARE, 

IS  RESPECTFULLY  PSESEJVTED. 


ERRATA. 

Page  18,  line  2,  for   "  vessels  of  the  brains,"'  read  t:  vessels,  of  the  brain  is." 
21,  line  8,  for   "  are,''  read  "  is." 
line  11,  for  "  are,"  read  "  is.'1 


IH 


4 


■ifyl{/7v$n// 


AN 

INAUGURAL  DISSERTATION 

ON 

INSANITY. 


o 


F  the  uncertainties  of  our  present  state,"  says 
Dr.  Johnson,  "  the  most  dreadful  and  alarming  is, 
the  uncertain  continuance  of  reason."    The  sage  was 
himself  a  mournful  example  of  what  melancholy,  and 
the  fear  of  the  loss  of  reason,  could  effect  in  a  mind 
at  once  original,  capacious,  and  powerful.     Indeed, 
men  of  genius  and  talents  seem,  in  many  instances, 
to  fall  victims  to  the  disease  of  insanity.     It  embit- 
tered the  life  of  Cowper ;  shrouded  in  mental  dark- 
ness the  declining  days  of  Swift ;  and  prostrated  the 
acute  understanding  of  Vicq.  D'Azyn     This  spec- 
tacle of  "  human  nature  in  ruins,"  which,  while  it 
attacks  the  learned  and  wise,  does  not  spare  those  en- 
gaged in  other  pursuits,  has  attracted  the  attention  of 
medical  men  and  philosophers  in  all  ages  and  coun- 
tries.    Their  examinations  have  thrown  light  on  a 
mysterious  subject,  but  much  remains  to  be  still  un- 
folded.    A  compilation  of  the  more  important  facts 
contained  in  their  writings,  relative  to  this  disease,  is 
all  that  can  be  expected  from  one  whose  opportuni- 
ties of  viewing   the  disease  have  been  scanty,   and 
whose  information  is  derived  chiefly  from  books. 

I 


10 

The  most  common,  and  probably  the  most  accu- 
rate division  of  the  faculties  and  powers  of  the  mind, 
is  that  into  understanding  and  will.  Under  the  for- 
mer are  included  perception,  or  the  impression  made 
by  external  objects  on  the  organs  of  sense,  the  nerves, 
and  the  brain,  and  conveyed,  by  means  of  conscious- 
ness, to  the  mind ;  memory,  comprehending  both  a 
power  of  retaining  knowledge,  and  of  recalling  it  to 
our  thoughts  when  occasion  requires  ;  judgment  and 
reason,  or  the  faculty  of  discerning  the  relation  of  one, 
thought  or  proposition  with  another,  and  drawing  in- 
ferences from  them  j  and  imagination,  whose  pro- 
vince it  is  to  make  a  selection  of  qualities  and  circum- 
stances from  various  sources,  and  by  combining  and 
disposing  them,  to  form  a  new  creation  of  its  own. 
To  these  may  be  added,  attention,  abstraction,  and 
conception.  The  will  comprehends  the  active  pow- 
ers, as  the  passions  and  affections.  In  most,  if  not 
in  all  the  operations  of  the  mind,  both  these  facul- 
ties concur.  Perception  is  one  that  arrives  to  matu- 
rity, even  in  infancy.  The  impressions  of  external 
objects  are  the  first  which  occur  to  the  view,  and 
consequently  claim  the  greatest  share  of  regard.  The 
rest  are  developed  and  improved  with  advancing 
years.  Memory,  assisted  by  attention*,  treasures 
up  the  knowledge  which  we  have  acquired ;  whilst 
reason,  in  a  well  governed  mind,  always  exercises  a 
commanding  sway  over  the  imagination  and  passions, 
regulating  the  excursions  of  the  one,  and  restrain- 
ing the  excesses  of  the  otherf. 

*  "  Attention  to  things  external  is  properly  called  observa- 
tion ;  and  attention  to  the  subjects  of  our  consciousness,  re- 
flection."— Reid. 

t  Vide  Reid  and  Stewart, 


il 

These  faculties  are,  however,  far  from  being  uni- 
form in  all  men.  They  are  influenced,  amongst  a 
variety  of  other  causes,  by  early  education^  habit, 
improper  association  of  ideas,  and  differences  in  the 
physical  constitution.  Through  the  varied  operation 
of  these  agents,  our  actions  in  life  are  guided,  and  ac- 
cording as  they  differ  from  the  standard  which  the 
general  sense  of  mankind  has  adopted,  are  regarded 
as  deviations  from  sanity  or  virtue.  The  diseases  of 
the  mind  included  under  the  former  are  numerous, 
and  have  been  called  by  various  names.  It  will  pro- 
bably simplify  our  remarks  on  them,  by  sketching 
those  of  the  more  important  faculties  separately.  Per- 
ception is  liable  to  injury,  both  in  itself  and  in  its 
immediate  organs.  The  senses  may  be  affected  in 
numberless  ways,  by  bodily  disease.  The  power 
itself  becomes  erroneous,  from  ignorance,  and  other 
subordinate  causes,  as  rashness  and  credulity.  Ob- 
jects are  also  at  different  times  presented  in  too  great 
rapidity,  or  too  slowly,  producing  the  different  states 
of  vertigo  and  ennui.  To  this  class  may  also  be 
referred  the  belief  in  the  appearance  of  apparitions*. 
It  appears  to  be  altogether  destroyed,  or  at  least  very 
seldom  brought  into  operation,  in  fatuity  or  idiotism, 
in  which  "  no  accurate  representation  of  any  exter- 
nal object,  and  no  abstract  thought  or  reflection  ever 
occursf."     The  memory  may  be  injured  by  various 

*  Vide  an  interesting  paper  "  on  Apparitions,  by  John 
Alderson,  M.D."  in  Edin.  Med.  and  Surg.  Journal,  vol.  vi. 
p.  287.  The  author  discusses  this  diseased  state  of  percep- 
tion) and  establishes  the  difference  between  it,  and  lesions  of 
ethet  faculties,  in  a  rational  and  conclusive  manner • 

t  Crichton  OH  Mental  Derangement,  vol.  I.  p.  314. 


12 

corporeal  agents,  for  which  I  need  only  refer  to  the. 
writings  of  practical  physicians.  It  decays  in  old 
age,  and  among  the  mental  causes  which  affect  it,  are 
to  be  included  inattention  and  over-exertion.  It  is 
a  remarkable  fact,  that  persons  advanced  in  life  re- 
member the  scenes  of  youth  much  better  than  the 
transactions  of  later  years.  The  same  thing  has  oc- 
curred in  cases  of  old,  incurable  lunatics*.  The 
judgment  and  reason,  the  peculiar  birthright  of  man, 
become  erroneous,  defective,  or  are  totally  destroyed. 
Prejudice,  passion, ignorance,  and  all  the  agents  which 
afivct  the  other  faculties,  assist  in  weakening  it. 
Among  the  disorders  of  the  imagination,  may  be  men- 
tioned reverie,  or  the  illusion  of  waking  dreams,  and 
too  great  sensibility.  The  latter  is  the  fruitful  source 
of  ills,  producing  enthusiasm,  fastidious  refinement, 
and  inattention  to  the  necessary  business  of  life.  The 
consequences  of  ill-regulated  passions  need  not  to  be 
mentioned.  The  other  powers  are  subject  to  similar 
imperfections.  All  of  them  are  more  or  less  disor- 
dered in  mental  derangement,  but  which  of  them  pri-? 
marily,  is  difficult  to  be  determined. 

An  analogy  has  been  supposed  by  some  to  exist  be- 
tween the  states  of  dreaming  and  insanity,  and  the  opin- 
ion has  some  foundation ;  particularly  if  Prof.  Stew- 
art's theory  be  correct,  viz.  that  the  power  of  the 
will  is  suspended  during  sleepf .  Dreams,  accord* 
ing  to  him,  vary  with  our  bodily  sensations,  the  pre- 
vailing temper  of  mind,  and  our  habits  of  association, 
when  awake.     The  distinction  of  Haslam,  which  is 

*  Haslam  on  Madness,  &c.  2d  edit.  p.  61. 
t  It  will,  however,  be  difficult  to  account  for  somnambu- 
Visin,  arid  talking  in  sleep,  on  this  supposition. 


is 

borrowed  from  Hartley,  that  in  madness  the  delusion 
is  conveyed  principally  through  the  ear,  while  in 
dreaming  it  is  optical,  will  hardly  stand  the  test  of 
fact.  A  remarkable  instance  to  the  contrary  is  relat- 
ed by  Dr.  Beattie,  in  his  Dissertation  on  Dreaming. 
From  the  foregoing  imperfect  sketch  of  the  "  Ana- 
tomy of  the  mind,"  it  will  be  seen  that  it  is  subject  to 
disease  as  well  as  the  body.  To  arrange  the  various 
kinds  according  to  their  proper  gradations,  is  almost 
impossible  in  the  present  imperfect  state  of  this 
science.  The  following  comprehends  most  of  those 
concerning  which  we  have  information.  Pleasant 
dreams*,  unpleasant  dreams,  somnambulism,  vigilia, 
erroneousness  of  judgment  in  children,  dotage  of  old 

*  Although  it  will  not  be  denied,  that  unpleasant  dreams 
are  a  state  of  disease,  yet  many  may  not  be  disposed  to  allow 
the  same  concerning  pleasant  ones.  Several  circumstan- 
ces, however,  tend  to  substantiate  this  assertion,  such  as  the 
necessity  of  rest  to  the  mind,  as  well  as  the  body,  the  dis- 
ordered state  of  the  imagination  during  sleep,  unswayed  by 
judgment,  and  the  fact  of  persons,  who  are  in  habits  of  think- 
ing, and  thus  causing  over-activity  of  the  mind,  dreaming 
much,  while  the  contrary  description  of  persons,  as  the  labour- 
er, do  not.  Locke,  (Essay,  book  2.  chap.  1.)  mentions  the  case 
of  a  gentleman  who  never  dreamt,  till  he  had  a  fever  in  the 
25th  year  of  his  age.  Dr.  Beattie,  (Dissert,  on  Dreaming,) 
mentions  a  person  who  never  dreamt  but  when  his  health 
was  disordered.  Medical  men  have  made  similar  observa- 
tions. "  Observamus  somnum,  qui  ante  mediam  noctcm 
capitur,  plus  incrementi  viribus  addere,  quant  qui  earn  sub- 
sequitur.  Ratio  haec  esse  vidctur,  quia,  homines  tunc 
temporis  profundiori  somno  merguntur."  Hoffman.  Opera 
Fol.  Tom.  1.  p.  126.  An.  1748.  Gregory,  (Conspectus,  vol. 
1.  p.  209.)  remarks,  "  Qui  sanissimi  altum  dormiunt,  iis 
ncquc  motus  voluntatius  est,  ncque  aensus  cxtcrnus,  ncque 
intcmi,  ei  fjuitfucnl,  ulla  memoria." 


14 

age,  reverie,  too  great  liveliness  of  imagination,  dis- 
ordered association  of  ideas,  frequent  recurrence  of 
the  same  train  of  thought,  loss  of  memory,  nervous 
affections,  violent  passions,  hypochondriasis,  hysteria, 
epilepsy,  madness,  melancholy,  fatuity,  together  with 
delirium,  and  other  affections  attendant  on  acute  dis- 
tempers. Many  of  these,  if  not  all,  are  connected 
with  diseases  of  the  body. 


HISTORY    OF    THE    DISEASE. 

IN  the  earliest  medical  writings  of  the  ancients, 
insanity  is  divided  into  melancholia  and  mania.  Al- 
though Hippocrates  has  left  us  no  particular  treatise 
on  this  subject,  yet  it  is  clearly  deducible  from  va- 
rious parts  of  his  works,  that  he  considered  them  as 
different  forms  of  disease*.  Aretoeus,  the  first  writer 
extant  who  treats  professedly  on  diseases  of  the  mind, 
adopts  this  distinction,  but  observes,  that  melancholy 
appears  to  him  to  be  the  commencement,  and  con- 
stitutes part  of  maniaf  ;  and  succeeding  writers,  with 
hardly  an  exception,  have  followed  this  arrangement, 
until  within  the  last  twenty  years.  Several  systems 
have  been  offered  to  the  world  J,  in  which  insanity  is 

*  Compare  Aphorisms,  Sect.  3.  Aphor.  20.  and  22.  and 
Sect.  6.  Aphor.  23.  with  Lib.  De  Morbo  Sacro,  Sect.  3.  p.  92. 
(Ed.  Foesii.) 

f  "  Mihi  profecto  melancholia  /uav/a?,  initium  atqne  pars 
esse  vjdetur."  Aretaeus  De  Caus  Diut.  affect,  lib.  1.  p.  29.  Ed. 
Boerhaave,  1735.  Caelius  Aurelianus  observes,  that  Themi- 
soji  and  his  disciples  were  of  the  same  opinion.  De  Morb. 
Chron.  lib.  1.  340.  Ed.  Amman. 

$  By  Drs.  Arnold,  Crichton,  and  Pine!. 


15 

divided  into  a  number  of  species ;  but  they  have  gene- 
rally been  found  as  useless  in  practice,  as  they  are 
difficult  to  be  distinguished  in  theory.  The  idea  of 
their  being  one  and  the  same  disease,  in  different 
forms,  according  to  the  temperament  and  constitution 
of  the  patient,  seems  not  unreasonable.  The  facts 
of  the  very  frequent  conversion  of  one  into  the  other  ; 
of  numbers  whose  lives  are  passed  between  furious 
and  melancholic  paroxysms,  and  under  both,  retaining 
the  same  set  of  ideas* ;  and  of  the  same  remedies, 
with  little  variation,  being  found  useful  for  both,  ma- 
terially strengthen  this  supposition.  Mr.  Haslam, 
whose  opportunities  of  viewing  the  disease  in  all  its 
varied  forms,  have  been  very  great,  observes,  "  In 
both  there  is  equal  derangement,  and  on  dissection, 
the  state  of  the  brain  does  not  show  any  appearances 
peculiar  to  melancholiaf."  As,  however,  the  symp- 
toms which  are  immediately  presented  to  our  view 
appear  so  diametrically  opposite,  it  will  be  proper  to 
retain  the  distinction.  Insanity  may  be  divided  into 
melancholy,  mania,  and  idiotism.  The  first  is  cha- 
racterised by  an  anxious  look,  love  of  solitude,  and 
excess  of  fear.  The  second  by  hurried  action,  lo- 
quacity, and  furious  raving.  The  last,  although  fre- 
quently the  termination  of  the  previous  ones,  is  in 
many  instances  an  idiopathic  disease:]:.  Its  peculiar 
character  has  been  already  noticed. 

Various  theories  have  been  proposed,  as  it  respects 
the  affection  of  the  mind  in  these  stages.  In  melan- 
choly   it  is   invariably    fixed  on  a  single  train  of 

•   Iluslam  on  Madness,  p.  33. 

t   Ilaslain,  |>. 

t   v  in  ilic  Cretiiw  of  Switzerland. 


thought* :  while  in  mania,  it  is  roving  with  rapidity 
from  one  subject  to  another.  By  an  application  of 
the  principles  already  laid  down,  the  difficulty  of  ar- 
riving at  any  certainty  on  this  point  will  be  immedi- 
ately perceived.  Maniacs,  in  many  instances,  have 
false  perceptions ;  that  is,  they  assert  they  have  seen 
objects  which  it  is  impossible  could  have  appeared  to 
them.  But  this  defect  is  not  universal.  In  some 
the  idea  is  evidently  derived  from  former  impressions, 
and  no  trace  can  be  perceived  of  diseased  perception. 
The  reasoning  faculty  also,  though  impaired,  is  not 
destroyed.  The  patient  argues  correctly  from  false 
premises.  We  are  ignorant  of  the  train  of  thought 
passing  in  his  mind,  and  judge  only  by  the  incoher- 
ence of  his  conversation,  which  may  be  owing  to  the 
rapidity  of  his  ideas,  and  his  expressing  only  part  of 
them.  The  ideas  may  be  represented  either  with  un-< 
natural  rapidity ',  unnatural  association^  or  unnatural 
vividness^.  The  passions  appear  occasionally  to  be 
the  seat  of  insanity,  unaccompanied  with  defect  of 
judgment  and  imagination.  The  whole  disease  in 
this  case  appears  to  consist  in  a  preternatural  suscep- 
tibility to  emotions.  It  may  be  said,  that  these  dif- 
ferent lesions  of  the  faculties  of  the  mind  certainly 
prove  the  existence  of  different  diseases  ;  but  the  ob- 
jection is  at  once  repelled  by  the  fact  of  a  single  pa- 
tient at  various  times  passing  through  all  the  grada- 
tions, from  furious    phrenzy  to   complete  fatuity. 

*  "  Est  autem  (in  melancholia)  animi  anger  in  una  cogita- 
tione  defixus."  Aretseus  ut  antea.  Dr.  Ferriar's  definition  of 
melancholy  is,  u  intensity  of  idea,"  grcniting  an  object  ex- 
elusive  attention. 

t  London  Med.  Review,  vol.  1.  p.  46. 


17 

The  following  is  the  most  correct  explanation, 
(though  liable  to  objection,)  which  the  author  has 
met  with,  and  is  one  that  will  elucidate  a  great  num- 
ber of  the  phenomena  that  occur.  "  The  true  rela- 
tion between  the  two  general  forms  of  insanity  may 
be  stated  to  consist  in  abstraction,  and  in  vivid  imagin- 
ation. The  one  will  comprehend  that  state,  where  the 
mind  separates  the  combinations  which  are  presented 
to  it,  and  fixes  its  attention  exclusively  upon  one 
single  object.  The  other  combines  the  different  ob- 
jects and  various  sensations,  creates  new  ones,  and 
mistakes  conceptions,  the  recollection  of  past  per- 
ceptions for  real  existences.*'' 

A  similar  diversity  of  opinion  has  taken  place, 
(though  not  in  so  great  a  degree,)  as  to  its  seat  in  the 
body.  Hippocrates  supposed  the  brain  to  be  affect- 
ed in  two  ways,  by  the  bile  and  pituita ;  the  heating 
and  cooling  principle.  The  one  causing  mania,  and 
the  other  melancholy f.  Aurelianus  supposed  the 
head  to  be  disordered  in  the  former,  and  the  stomach 
in  the  latter  J.  The  moderns  in  general  refer  it  to  the 
brain,  allowing,  however,  in  some  instances,  that  the 
stomach  is  the  primary  organ  diseased.     A  kind  of 

*  Edinburgh  Review,  vol.  2.  p.  169. 

t  "  At  cerebri  corruptio  ex  pituita  et  bile  oritur,  utrum- 
que  autem  hoc  modo  dignosces.  Qui  ex  pituita  quidem  in- 
saniunt,  quieti  sunt,  neque  vociferantur,  neque  tumultuan- 
tur  ;  qui  vero  ex  bile,  clamosi,  maligni  et  minime  quieti, 
semper  aliquid  intempestivum  faciunt.  Ex  his  igitur  causis 
continue  insaniunt."  De  Morbo  Sacro  Sect.  3.  p.  92.  line  36. 
(Ed.  Focsii  ) 

\  "  Differt  autem,  siqr.idem  in  ista  (melancholia)  principa- 
liter  stomachus  patitur,  in  furiosis  vcro  caput."  Lael.  Aure» 
lian.  ut  antea. 

C 


18 

chronic  inflammation  or  plethora  of  the  vessels  of  the 
brains,  supposed  by  many  to  occur.  In  what  the  other 
changes  from  health  consist,  it  is  difficult  to  explain. 

The  diagnosis,  or  distinguishing  symptom  of  insa- 
nity, has  been  universally  stated  to  be  "  delirium  sine 
febre."  The  correctness  of  this  is  destroyed,  by  the 
fact,  of  a  patient  during  the  hysteric  paroxysms  be- 
ing in  the  same  situation* 

The  difficulty  of  giving  a  correct  definition,  has 
been  of  late  unwillingly  acknowledged.  "  There 
is,  indeed,  a  double  difficulty ;  the  definition  ought 
to  comprehend  the  aberrations  of  the  lunatic,  and  fix 
the  standard  of  the  practitioner.  But  it  may  be  as- 
sumed, that  sound  mind  and  insanity  stand  in  the 
same  predicament,  and  are  opposed  to  each  other  in 
the  same  manner  as  right  and  wrong,  and  as  truth  to 
the  lie*." 


SYMPTOMS. 

IN  many  instances,  an  attack  of  insanity  is  pre- 
ceded by  pain  in  the  head,  throbbing  of  the  arteries, 
and  even  giddiness;  tightness  about  the  region  of 
the  abdomen,  want  of  appetite,  peculiar  sensation  in 
the  intestines,  costiveness,  loss  of  sleep.  All  the 
patients  agree  that  they  feel  confused  from  the  sudden 
and  rapid  intrusion  of  unconnected  thoughts. 

They  who  are  attacked  with  mania  become  unea- 
sy ;  are  unable  to  confine  their  attention ;  are  loqua- 
cious ;  walk  with  a  quick  and  hurried  step,  and  stop 
suddenly.  They  express  their  opinions  with  great 
fervency  and  extravagance,  and  are  highly  impatient 
*  Haslam,  p.  37. 


19 

of  reproof.  Some  laugh,  cry,  and  sing,  by  turns. 
The  eyes  protrude,  and  are  often  glistening.  The 
cheeks  are  flushed.  A  relaxation  of  the  integuments 
of  the  occiput,  together  with  contraction  of  the  iris, 
occur  in  some  cases.  A  very  vigorous  action  of 
both  body  and  mind  takes  place,  particularly  great 
muscular  strength.  Some  fancy  themselves  kings, 
prophets,  &c.  Some  feel  an  ungovernable  incli- 
nation to  acts  of  fury  and  violence,  and  maim  and 
murder  those  whom  they  can  approach.  They  be- 
come suspicious  of  plots.  This  fury  increases,  until 
at  last  confinement  is  necessary  ;  while  in  that  situa- 
tion they  are  observed  to  continue  a  particular  action 
for  a  length  of  time,  such  as  shaking  their  chains,  or 
beating  with  their  feet.  They  readily  yield  to  supe- 
rior force,  and  a  stern  countenance. 

The  melancholic  attack,  on  the  other  hand,  com- 
mences with  a  gloomy,  anxious  countenance ;  little 
disposition  to  speak ;  avoidance  of  company,  frequent- 
ly keeping  the  eye  "  bent  on  vacuity,"  for  hours. 
The  patient  often  bursts  into  tears  ;  imagines  he  has 
committed  some  heinous  crime,  and  not  unfrequently 
finishes  his  hated  existence. 

The  maniac  and  melancholic,  however,  do  not  al- 
ways remain  in  these  situations;  the  paroxysms  abate, 
and  are  succeeded  by  calmness,  and  a  certain  degree 
of  rationality.  This  has  been  called  the  lucid  interval. 
"  I  have  no  where,"  says  Pinel,  "  met,  excepting  in 
romances,  with  fonder  husbands,  more  affectionate  pa- 
rents, more  impassioned  lovers,  more  pure  and  exalted 
patriots,  than  in  the  lunatic  asylum,  during  the  inter- 
vals of  calmness  and  reason-.     Its  duration  is,  how- 

•  Pine  i  on  Inanity,  translated  by  Dr.  Davis,  p,  16 


2® 

ever,  very  uncertain,  and  ought  to  have  no  weight 
with  the  physician,  as  to  preventing  watchfulness, 
and  pursuing  the  proper  method  of  cure.  The  ex- 
haustion that  follows  the  paroxysm  is  highly  danger- 
ous, and  must  be  carefully  guarded  against*. 

Madmen  are  said  to  possess  the  power  of  resisting 
cold;  but  this  is  denied  by  late  writers.  Mr.  Has- 
lam  observes,  that  they  are  very  subject  to  mortifica- 
tion of  the  toes  from  exposure  to  inclement  weatherf . 
Those  that  are  permitted  to  walk  about  are  always 
found  near  the  fire  in  winter.  Probably  the  great 
engagement  of  the  mind  causes  insensibility  during 
the  paroxysm.  They  are  also  said  to  possess  the 
power  of  resisting  hunger.  Many  refuse  food,  from 
an  apprehension  ol  being  poisoned.  In  some  instan- 
ces the  fasting  has  been  prolonged  to  fourteen  days  J. 
Mr.  Pinel  gives  a  melancholy  account  of  the  mortality 
in  the  Asylums  of  France,  during  the  storms  of  the  re- 
volution, when  the  daily  allowance  of  bread  was  re- 
duced §. 

Of  the  organs  of  sense  the  ear  is  most  affected ;  ma- 
ny become  deaf,  but  very  few  blind||.  The  majority 
of  patients  grow  worse  from  lying  in  the  recumbent 
posture.  Of  265  lunatics,  in  Bethlem  hospital,  who 
were  examined,  205  were  swarthy,  with  dark  or  black 

*  Haslam,  Pinel,  and  Ferriar.  "  Whoever,"  says  the  latter, 
"  would  gain  a  knowledge  of  the  symptoms  of  madness  from 
books,  more  particularly  than  that  afforded  by  Aretaeus,  must 
consult  Shaksfteare."  In  proof  of  this  I  need  only  refer  to 
the  tragedies  of  Lear,  Macbeth,  and  Hamlet. 

t  P.  84. 

%  Annals  of  Medicine,  vol.  5.  p.  383. 

§  Pinel,  p.  33.  and  209. 

I|  Haslam,  p.  67. 


21 

hair,  and  60  with  fair  skin,  and  light,  brown,  and  red 
haired*.  It  is  a  remark  made  by  Hoffman,  and  confirm- 
ed by  experience,  that  maniacs  are  not  subject  to  epi- 
demics. Dr.  Hosack  informs  me,  that  none  were  at- 
tacked with  yellow  fever  during  its  prevalence  in  this 
city.  Other  diseases  are  also  removed  by  its  at- 
tack f. 

The  appearance  of  idiots  are  marked  by  looks  de- 
void of  animation,  and  motion  slow  and  mechan- 
ical. The  senses  are  imperfectly  developed,  and  the 
train  of  ideas,  (if  any  exist,)  are  very  slow  and  fee- 
ble. Many  of  them,  after  remaining  in  this  state  for 
years,  are  attacked  with  paroxysms  of  active  mania, 
and  the  symptom  is  favourable,  since  in  some  cases 
it  is  succeeded  by  a  return  of  reasonj.  Congenite 
idiotism  is  found  in  the  Vallais  in  Switzerland,  in  Sa- 
voy, in  the  island  of  Sumatra,  in  Chinese  Tartary, 
near  the  great  wall,  as  observed  by  Sir  George  Staun- 
ton§.  In  most  cases  they  are  affected  with  goitre.  A 
diminution  of  the  size,  of  the  cranium,  as  well  as  of  the 
brain,  is  also  said  to  occur|| .    This  interesting  subject 

*  Haslam,  p.  83.  «  Novimus  enim  hirsutos,  nigroque  colo- 
re et  habitu  tcnues,  multo  facilius  quam  candidos  et  cras- 
siores,  melancholia  corripi."  Alex.  Trallian,  voi.  1.  p.  84.  (Ed. 
Haller,   1772.) 

t  Vide  Mead's  Med.  Precepts,  and  Ferriar  on  the  Con- 
Version  of  Diseases. 

\  Pinel,  p.  168. 

§  Coxe's  Travels  in  Switzerland,  4th  edit.  vol.  1.  p.  420. 
et  Seq. 

||  in  a  Lecture  on  Physiology,  delivered  at  Paris,  by  Dr. 
Gall,  Jan.  15,  1808,  he  stated  as  his  opinion,  that  the  power 
of  intelligence  was  in  proportion  to  the  dcvclop.-mcnt  of  the 
hniin.     Thus  stupid  animals  have  very  little  brain,  sagacious 


m 


is  further  elucidated  in  Foder6  "  Essai  sur  le  Goitre 
,et  Cretenisme,"  and  in  Dr.  Reeve's  "  Account  of 
Cretenism,,,  in  Edin.  Med.  &,  Surg.  Journal,  vol.  5. 
p.  31. 


CAUSES. 

THE  remote  causes  of  insanity  are  either  bodily 
or  mental. 

Bodily  causes.  Repeated  intoxication  ;  blows,  and 
other  injuries  on  the  head  ;  fever,  particularly  when 
attended  with  delirium  ;  cutaneous  eruptions  repell- 
ed ;  suppression  of  periodical  or  occasional  dis- 
charges and  secretions ;  excessive  evacuations  ;  mer- 
cury largely  and  injudiciously  administered*  ;  para- 
lytic affections ;  great  heat  of  climate ;  coup  de  so- 
leil;  changes  of  the  moonf  ;  influence  of  the  sea- 
sons, particularly  suramerf ;  in  England,  the  month 
of  November  ;  hereditary  predisposition  ;  melancho- 
lic, and  probably  the  sanguineous  temperament; 
manufactures  §. 

ones  more,  none  so  much  as  man  ;  and  among  men  idiots  ar« 
remarkable  for  smallness  of  the  head,  and  paucity  of  brain. 
He  exhibited  the  heads  of  several  idiots  in  proof  of  this  po- 
sition.    Literary  Panorama,  vol.  4.  p.  1 64. 

*  Haslam. 

t  Hence  called  lunatics.  This  cause,  although  denied  by 
Haslam  and  others  to  be  one,  has  the  testimony  of  many  phy- 
sicians in  favour  of  it,  and  among  the  rest  may  be  named  Dr. 
Balfour  in  his  Theory  of  Sol  Lunar  Influence.  Vide  Asiatic 
Researches,  vol.  8th. 

\  Pinel. 

§  According  to  the  Report  of  the  Committee  of  the 
House  of  Commons,  in  18u7,  Lancashire  has  272  lunatics^ 


23 

Mental  causes.  The  principal  source  of  these  is, 
errors  in  early  education ;  pursuing  a  system  which 
injures  the  body,  gives  free  scope  to  the  pas- 
sions, and  does  not  discipline  the  intellect.  It  would 
be  a  highly  interesting  speculation,  to  consider,  in 
connexion  with  this  subject,  the  differences  in  the 
moral  and  physical  constitution  of  man,  produced  by 
successive  changes  from  barbarism  to  civilization;  to- 
gether with  the  influence  of  increase  of  wealth  and 
luxury.  National  character  deserves  also  to  be  no- 
ticed. England,  Switzerland,  and  Spain,  have  the 
greatest  number  of  lunatics,  in  proportion  to  their 
population,  of  any  countries  in  Europe.  In  France 
there  were  but  few,  until  the  Revolution*.  The  fre- 
quent and  uncurbed  indulgence  of  any  violent  pas- 
sions or  emotions  a*e  the  most  common  mental 
caused.  Gray  has  delineated  their  effects  with  gra- 
phic accuracy. — 

These  shall  the  fury  passions  tear, 
The  vultures  of  the  mind, 
Disdainful  anger,  pallid  fear., 
And  shame  that  skulks  hehind  ; 
Or  pining  love  shall  waste  their  youth,, 
Or  jealousy  with  rankling  tooth, 
That  inly  gnaws  the  secret  heart, 
And  envy  wan,  and  faded  care, 
Grim  visag'd  comfortless  desflair, 
And  sorrow's  piercing  dart. 


outofapopulation  of  670,000, while  the  countiesof  Cambridge, 
Huntingdon]  Hertford,  and  Essex,  have  7,  out  of  444,000.  The 
East  Riding  of  Yorkshire  three  ;  North  Riding,  twenty-three  ; 
while  the  West  Riding  lias  424.  Literary  Panorama,  vol.  2. 
p.  \25'J. 

'   Anmld  on  Insanity,  vol.  1.  Met  3 


24 

Ambition  this  shall  tempt  to  rise, 
Then  whirl  the  wretch  from  high. 
To  bitter  scorn  a  sacrifice, 
And  grinning  infamy. 

Avarice,  domestic  misfortunes,  commercial  specu- 
lations*, political  contests!,  enthusiastic  patriotism^, 
mistaken  ideas  of  religion  causing  either  enthusiasm 
or  superstition,  and  sudden  joy,  may  also  be  men- 
tioned. Minds  destitute  of  order  in  their  intellectual 
operations,  are  much  predisposed  to  insanity. 

Of  113  madmen  confined  atBicetre,  in  1795,  Mr. 
Pinel  found,  that  34  were  reduced  to  that  state  by- 
domestic  misfortunes,  24  by  disappointments  in  love, 
30  by  events  connected  with  the  Revolution,  and  25 
by  religious  fanaticism.  The  subjects  were  princi- 
pally monks,  many  artists,  painters,  and  musicians, 
versifiers,  *'  who  have  all  the  melancholy  madness  of 
poetry,  without  its  inspiration;"  and  a  great  number 
of  advocates  and  attornies.  No  instances  of  a  single 
physician,  chemist,  or  mathematician §. 

Of  the  Proximate  Cause  we  know  nothing. 


DISSECTIONS. 

IT  is  well  observed  by  Dr.  Arnold,  that  in  no 
disease  are  the  appearances  on  dissection  more  falla- 
cious, as  to  guiding  us  in  our  opinion  of  the  seat  and 
cause  of  it,  than  in   insanity.     According  to  him 

*  Willan. 

t  Rush. 

}  Pinel,  p.  15. 

§  Pinel,  p.  113,  114 


this  must  be  attributed  to  the  danger  of  mistaking  ef- 
fects for  causes.  The  following  are  among  the  more 
remarkable  appearances  of  the  brain,  which  occurred 
in  the  dissections  of  Morgagni,  Greding*,  and  Has- 
lam.  The  dura  and  pia  mater  diseased,  and  water 
between  them.  The  consistence  of  the  brain  in  most 
instances  soft,  in  some  cases  quite  elasticf.  Pineal 
gland  diseased.  Water  in  the  -ventricles.  Hydatids 
on  the  plexus  choroides.  Vessels  of  the  brain  dis- 
tended, and  the  brain  itself  showing  marks  of  inflam- 
mation or  congestion.  In  slight  cases,  nothing  parti- 
cular was  observed,  except  a  determination  of  blood. 
Nothing  important  was  observed  in  the  viscera.  M. 
Prost,  a  physician  in  Paris,  places  insanity  in  the  sto- 
mach and  bowels,  as  he  has  found  the  intestines  and 
gall  bladder  diseased  in  several  dissections  of  ma- 
niacjs.  Mr.  Pinel  supposes,  that  in  the  majority  of 
cases  there  is  no  organic  lsesion  of  the  brain,  on  ac- 
count of  the  success  which  attended  the  exclusive  use 
of  moral  management^. 


PROGNOSIS. 

Sex.  By  a  reference  to  the  Appendix,  it  will  be 
Been,  that  in  England  females  are  more  liable  to  this 
complaint  than  men  ;  whilst  on  the  continent  the  con- 
trary takes  place || . 

•  Medical  Aphorisms,  translated  by  Crichton. 
t  Haslam,  chap.  3. 

J    Edin    Med.  &  Surg.  Journal,  vol.  1.  p.  455. 
S  Pinel,  p.  5. 

|,  M  V'iri  sane  et  furore  ct  melancholia  corripiuntur ;  ra- 
rius  autem   quam   viri,  led  dctcrius  mulicres  funis  agitajltUI*. 

I) 


26 

Age.  By  a  similar  examination  it  appears,  that  the 
number  of  patients  admitted  at  Bethlem  and  Bicetre, 
between  the  age  of  30  and  40,  were  greater,  than  be- 
tween any  other  ten  years.  This  is  probably  owing 
to  the  circumstances  of  misfortunes  affecting  the  mind 
more  sensibly  at  that  time  of  life,  when  a  family  is 
generally  to  be  provided  for.  Intoxication  is  also  rea- 
dily induced  at  that  age,  from  similar  causes ;  and  the 
hereditary  predisposition,  (if  any  exists,)  will  make 
its  appearance.  Instances  of  insane  children  are  rare. 
Mr.  Haslam  relates  three  cases,  of  the  respective 
ages  of  three,  seven,  and  ten  years*. 

State  of  Disease.  Of  100  patients  in  a  furious 
state,  62  were  cured  :  of  100  melancholic,  only  27f . 
If  the  disease  arise  from  physical  causes,  the  prog- 
nosis is  more  favourable  than  when  from  moral  ones ; 
thus,  of  80  cases  of  puerperal  mania,  50  recoveredf . 
The  chance  of  cure  is  diminished  in  proportion  to 
the  length  of  time  that  the  disease  has  remained. 
The  frequent  alternations  of  raving  and  melancholy 
madness  are  unfavourable,  as  are  also  those  in  which  the 
temper  is  more  affected  than  the  understanding^.  Hea- 
viness after  the  paroxysm,  hsemoptisis  and  cutaneous 
eruptions,  are  favourable  symptoms.  Relapses  are  fre- 
quent from  affections  of  the  mind,  or  error  in  diet  and 
regimen.     Madness,  of  the  hereditary  or  religious 

.Etas,  qure  prope  statum  est,  et  ipse  status  huic  malo  subji- 
ciuntur."  Aretseus,  Lib.  1.  De  Caus.  Morb.  Diutur.  p.  30. 

*  Haslam,  chap.  4. 

t  Haslam,  p.  257. 

|  Haslam,  p.  247. 

§  Ferriar's  Essay  on  Insanity,  in  Med.  Hist.  8c  Reflect, 
vol.  2. 


27 

kinds  ;  or  complicated  with  epilepsy  and  paralysis,  or 
gradually  declining  into  idiotism,  is  generally  incur- 
able. In  addition  to  the  statements  in  the  appendix,  it 
may  be  added,  that  Dr.  Willis  deposed,  that  of  patients 
committed  to  him  within  three  months  after  the  attack, 
nine  out  often  recovered ;  and  Dr.  Arnold  states,  that 
in  his  own  private  establishment,  and  the  Leicester  lu- 
natic asylum,  two  thirds  of  those  admitted  are  cured*. 
Dr.  Rush  is  said  to  have  cured  twelve  out  of  thirteen  ; 
and  of  recent  cases  cures  four  out  of  fivef. 

Termination.  It  is  an  observation  of  Celsusf ,  and 
confirmed  by  succeeding  writers,  that  insanity  does 
not  prevent  patients  from  arriving  at  old  age.  Dr. 
Heberden  attributes  this  to  the  parts  of  the  brain,  which 
are  subservient  to  animal  life,  being  distinct  from  those 
which  are  essential  to  the  use  of  reason $.  Lunatics 
are  very  subject  to  diarrhea.  The  diseases  which 
generally  close  their  unhappy  existence  are,  apoplexy, 
palsy,  phthisis,  atrophy,  and  hydrothorax||. 


CURE. 

AS  the  causes  are  of  different  kinds,  so  it  is  pro- 
per  that  the  cure  should  be  appropriate  to  each.  For 
the  removal  of  insanity  arising  from  mental  causes, 
a  method  is  at  present  pursued,  styled  in  general, 

MoralManagement.  This  consists  in  removing 

•  Quarterly  Review,  vol.  2.  p.  160. 

t  This  fact  is  communicated  to  the  author'  by  Prof.  J. 
A.  Smith. 

\   l)c  Medicina,  lib.  1.  sect.  18.  "  Ut  vitam  non  impediat." 
$  flcbcrdcn's  Med.  Commentaries,  p.  277. 

(I  Greding. 


28 

patients  from  their  residence  to  some  proper  asylum  ; 
and  for  this  purpose,  a  calm  retreat  in  the  country  is  to 
be  preferred :  for  it  is  found  that  continuance  at  home 
aggravates  the  disease,  as  the  improper  association  of 
ideas  cannot  be  destroyed.  A  system  of  humane 
vigilance  is  adopted.  Coercion,  by  blows,  stripes, 
and  chains,  although  sanctioned  by  the  authority  of 
CeJsus  and  Cullen,  is  now  justly  laid  aside.  The  rules 
most  proper  to  be  observed  are  the  following :  Con- 
vince the  lunatics  that  the  power  of  the  physician  and 
keeper  is  absolute  ;  have  humane  attendants,  who  shall 
act  as  servants  to  them  ;  never  threaten  but  execute  ; 
offer  no  indignities  to  them,  as  they  have  a  high 
sense  of  honour ;  punish  disobedience  perempto- 
rily, in  the  presence  of  the  other  maniacs  :  if  unruly, 
forbid  them  the  company  of  others,  use  the  strait 
waistcoat,  confine  them  in  a  dark  and  quiet  room,  order 
spare  diet,  and  if  danger  is  apprehended,  apply  me- 
tallic manacles  to  their  hands  and  feet,  as  they  are 
found  not  to  injure  by  friction  so  much  as  linen  or 
cotton  ;  tolerate  noisy  ejaculations  ;  strictly  exclude 
visitors ;  let  their  fears  and  resentments  be  soothed 
without  unnecessary  opposition  ;  adopt  a  system  of 
regularity ;  make  them  rise,  take  exercise  and  food 
at  stated  times.  The  diet  ought  to  be  light,  and  easy 
of  digestion,  but  never  too  low.  When  convales- 
cent, allow  limited  liberty ;  introduce  entertaining 
books  and  conversation,  exhilirating  music,  employ- 
ment of  body  in  agricultural  pursuits,  as  is  the  case  in 
the  hospitals  of  York  and  Saragossa;  and  admit  friends 
under  proper  restrictions.  It  will  also  be  proper  to  for- 
bid their  returning  home  too  soon.  By  thus  acting,  the 
patient  will  "  minister  to  himself." 


29 

Remedies.  A  comparison  of  the  ancients  with  the 
moderns  in  this  particular,  will  fully  prove,  that  but 
few  important  improvements  have  been  made  by  the 
latter.  A  general  abstract  of  the  practice  of  the 
most  distinguished  of  each,  is  all  that  the  length  of 
this  Dissertation  will  allow.  Aretasus  recommends 
moderate  venisection  ;  to  be  repeated,  if  the  patient 
is  plethoric,  purging  with  black  hellebore,  and  in 
some  cases  emetics  ;  nourishing  diet.  If  arising  from 
suppressed  discharges,  more  active  remedies  are  ad- 
vised. He  also  mentions  bathing  in  warm  mineral 
waters,  friction  with  oil,  and  purges  exhibited  occa- 
sionally for  a  length  of  time*.  Trallian  has  similar  di- 
rections ;  he  prefers  topical  bleeding,  as  it  does  not 
debilitate  so  much  as  venisection.  He  also  recom- 
mends the  warm  bath  highly,  and  condemns  the  use 
of  white  hellebore,  as  a  vomit,  being  too  violentf .  It 
is  remarkable,  that  in  the  writings  of  the  ancients,  no 
traces  are  to  be  found  of  their  considering  hellebore 
as  a  specific,  although  this  is  the  received  opinion.  It 
has  probably  arisen  from  the  poet's  enlarging  on  its 
virtues  in  a  metaphorical  manner.  Aurelianus  re- 
commends shaving  of  the  head,  and  the  application 
of  sinapisms  J.  Celsus  speaks  in  high  terms  of  the 
use  of  cold  water  to  the  head§.  Poppies  applied 
to  the  head  were  advised  by  some,  but  it  does  not  ap- 
pear that  they  were  generally  used. 

•  Arctceus  Dc  Curat.  Diut.  Affect,  lib.  1.  chap.  5. 

t  Trallian,  lib.  i.  chap.  17. 

\  Aurelianus,  Dc  Morb.  Chron.  lib.  l.chap.  5  and  6.  He 
rcj<  .  is  a  remedy  that  had  been  advised  by  some,  and  gives 
tin  following  reason  :  "  Quippe  cum  sit  possibile  ex  consuetis 
"    P.  341. 

§  Celsus,  lib.  3.  sect.  18. 


30 

Dr.  Harvey's  method  of  cure  was  by  repeated 
bleedings,  mild  purges,  and  chalybeatesf .  Dr.  Tho- 
mas Willis  speaks  in  high  terms  of  iron  in  melancho- 
ly!. The  practice  of  Hoffman  is  similar  to  the  above. 
Dr.  Mead,  besides  these  remedies,  advises  attention 
to  the  evacuation  by  urine  in  cases  of  madness,  and 
directs  nitre  to  be  used.  He  found  blisters  hurtful 
in  most  cases,  and  preferred  setons  in  the  neck.  He 
also  gave  medicines  to  promote  perspiration  ;  ordered 
frequent  use  of  the  cold  bath ;  and  in  some  instan- 
ces prescribed  anodynes  §. 

Among  the  practitioners  of  the  last  century  and 
the  present  day,  the  method  of  cure  of  the  following 
deserves  notice.  Dr.  Ferriar  found  single  emetics  at 
the  commencement  of  the  disease  useful,  but  objects 
to  nauseating  doses  of  tartrite  of  antimony  frequently 
repeated,  and  gives  cautions  similar  to  the  above  nam- 
ed with  respect  to  venEesection.  He  speaks  in  very 
high  terms  of  the  strict  antiphlogistic  treatment  in 
cases  arising  from  intemperance,  but  has  found 
camphor,  digitalis,  and  opium,  even  in  large  quan- 
tities, of  no  benefit.  He  uses  the  warm  bath  in 
mania,  and  the  cold,  together  with  bark  and  wine, 
in  melancholy,  with  great  advantage.  Setons  and 
blisters,  were  found  beneficial.  Under  the  head  of 
purges,  he  prefers  calomel,  but  in  several  cases 
where  he  gave  it  so  as  to  cause  salivation,  it  pro- 

t  "  De  se  testatur,  quod  aliquot  maniacos  per  vensesec- 
tionem,  bis  vel  ter  repetitas,  lenes  purgationes  et  medica- 
menta  antihypochondriaca  mineralia,  intra  sex  septimanas  feli- 
citer  curaverit."  De  Vanitatibus,  &c.  Medicorum  ;  In  Acta 
Eruditorum,  i701.  p.  438. 

\  "  De  Anima  Brutorum"  in  Opera,  1695.  vol.  2.  p.  278, 

§  Mead's  Medical  Precepts  and  Cautions* 


31 

duced  no  sensible  effect  on  die  disease*.  Mr: 
Haslam  prefers  blood  drawn  from  die  head  by  cup- 
ping, to  any  other  method.  He  has  found  cathartics 
of  great  service.  Jalap  and  senna  are  principally  used. 
He  found  emetics  and  cold  baths  hurtful,  in  many  cases 
inducing  paralytic  affections ;  and  opium  and  setons 
useless.  Blisters  applied  to  the  legs  were  advantageous, 
in  some  instances! .  Prof.  Pinel  speaks  slightingly  of 
all  kind  of  remedies,  as  he  considers  the  disease 
to  be  curable  by  moral  management  alone.  He  re- 
commends however  a  few  drams  of  sulphate  of  mag- 
nesia, as  an  excellent  preventive  of  approaching 
paroxysms  J.  Dr.  Chiarugi,  of  Florence,  speaks  in 
very  high  terms,  of  friction  with  opium  ointment ;  it 
produced  calmness  in  every  case,  and  in  some  it  af- 
fected a  cure§.  Dr.  Cox  uses  the  rotatory  swing  with 
similar  success.  Dr.  Rush  recommends  venae  section 
to  a  large  extent ;  mercury  given  so  as  to  cause  saliva- 
tion ;  warm  and  cold  bath  ;  blisters  to  the  ancles ; 
together  with  fresh  air  and  gentle  exercise||.  The 
famous  Dr.  Francis  Willis,  who  attended  the  pre- 
sent king  of  England,  and  the  queen  of  Portu- 
gal, during  their  insanity,  is   said  to  have  prefer- 

•  Medical  Histories  and  Reflections,  1810.  vol.  1.214;  and 
vol.  2.  p.  107.  In  the  Nova  Acta  Curios,  vol.  1.  p.  346.  is 
related  a  case,  cured  by  mercurial  friction  in  a  month,  after 
all   previous  remedies  had  failed. 

t  Haslam,  chap.  8.  Dr.  Hosack  informs  me,  that  he  hus 
found  blisters  applied  to  the  head,  and  continued  fora  length 
ol  time,  of  great  use. 

{    I'age  44. 

%  Annals  of  Medicine*  vol.  3.  p.  105. 

||  Med.  Inquiries  and  Observations,  3d  edit.  vol.  4.  p.  416. 
V  Coxe'l  Med.  .Museum,  vol.  4.  p.  136. 


32 

red  emetics.  Opium  he  thought  did  harm ;  and 
when  narcotics  were  required,  he  employed  hyos- 
cyamus.  Blisters  on  the  neck  he  found  hurtful. 
Digitalis  was  considered  proper  in  some  cases,  as 
was  also  the  warm  bath*.  In  the  case  of  George 
III.  which  he  attributed  to  weighty  business,  severe 
exercise,  and  too  great  abstemiousness;  the  bark, 
after  a  little  calomel  and  a  cathartic,  appeared  to  be 
productive  of  very  decided  advantage!. 

NOTE. — The  Harvey,  noticed  above,  was  Dr. 
Gideon  Harvey,  physician  to  Charles  II.  in  his  exile. 
He  flourished  at  the  end  of  the  seventeenth  century. 


MEDICAL    JURISPRUDENCE    AND    POLICE. 

THE  Medical  Jurisprudence  of  Lunatics  may  be 
considered  in  two  points  of  view.  1.  The  security  of 
the  public,  and  2.  The  proper  treatment  of  the  pa- 
tients. 

To  effect  the  first,  it  becomes  absolutely  necessary 
that  they  should  be  confined  in  some  convenient 
place,  in  order  to  prevent  the  commission  of  crimes, 
to  which  they  are  all  more  or  less  liable.  The  law 
has  humanely  forbidden  the  exercise  of  punishment 
on  them,  since  its  ends  cannot  be  answered.  "  So- 
ciety," (says  Dr.  Johnstone,  and  the  sentiment  is  ap- 
plauded by  all  good  men,)  "  may  obtain  an  adequate 
protection  by  the  confinement  of  maniacs,  without 
blood.''   Cases  frequently  occur,  where  medical  men 

*  Edin.  Med.  8c  Surg.  Journal,  vol.  4.  p.  195. 
t  Quarterly  Review,  vol.  2.  p.  168. 


3S 

are  called  on  to  decide  before  a  jury  respecting  the  state 
of  a  person's  mind,  who  has  committed  a  crime,  or 
made  an  unjust  will.  In  both,  it  is  of  importance,  that 
they  should  have  formed  proper  opinions  on  the  se- 
veral symptoms  of  this  disease,  for  in  none  are  men 
more  apt  to  err,  than  on  the  apparent  sanity  of  a  ma- 
niac. The  term  lucid  interval  has  been  applied  to 
this  state.  In  matters  of  law,  the  following  observa- 
tion of  Mr.  Haslam  is  certainly  the  most  proper  to 
guide  us  :  "I  should  define  a  lucid  interval  to  be  a 
complete  recovery  of  the  patient's  intellects,  ascer- 
tained by  repeated  examinations  of  his  conversation, 
and  by  constant  observation  of  his  conduct,  for  a  time 
sufficient  to  form  a  correct  judgment*."  Dr.  John- 
stone notices  a  discordance  in  the  laws  of  England, 
which  is  highly  disgraceful  to  a  civilized  nation.  In 
matters  of  property,  the  law  forbids  the  restoration 
of  it,  until  the  return  of  perfect  reason  and  intellect, 
while  merely  appearances  of  sanity  during  the  mo- 
ment of  committing  a  crime,  are  sufficient  to  condemn 
the  maniac,  although  insane  both  before  and  afterf. 
"Whether  this  inhuman  statute  has  force  in  our  own 
country,  the  writer  is  unable  to  learn.t/ 

2.  The  Treatment  of  Patients.  Different  methods 
have  been  pursued  for  this  purpose,  according  to  the 

•  Haslam,  p.  46. 

t  Medical  Jurisprudence  of  Madness,  by  J.  Johnstone,  M. 
D.  1800. 

J  Dr.  Mahon,in  his  Legal  Medicine,  observes,  that  in  cases 
of  maniacs  committing  crimes,  we  should  follow  the  maxim 
of    enlightened    jurisconsults.     "    Scmcl   furiosus,  semper 
presumitur  furiosus,  et  contrarium  tencnti  incumbit  onus  pro 
bandi  ■anam  mentcm."  Lond.  Med.   &.  I'hvs.    Journ.  voi.  9. 

p.  ra. 

» 


S4 

inclination  of  relatives,  or  the  laws  of  the  country. 
Thus  criminal  lunatics  have  been  [confined  in  jails, 
but  this  is  evidently  incompatible  with  proper  attend- 
ance, and  the  safety  of  the  other  prisoners.  Nor  is 
the  plan  of  confinement  in  private  mad-houses,  free 
from  objection.  Even  if  their  superintendants  be 
humane,  the  accommodations  are  generally  insuffi- 
cient and  inadequate  for  public  security,  since  the 
instances  of  escape  from  them  are  numerous.  But 
more  important  charges  may  be  brought  against 
them.  They  may  be  made,  (and  in  Great-Britain  are 
made,)  the  lw«%  tombs  of  the  victims  of  avarice  and 
revenge.  In  them  the  most  dreadful  cruelty  may  be 
exercised  with  impunity.  To  feel  the  justice  of  these 
censures,  it  is  only  necessary  for  any  person  to  ask 
himself  the  question,  What  would  be  his  feelings, 
were  a  relative  or  friend  secluded  in  these  abodes, 
through  the  malice  of  others  ?  If  private  mad-houses 
are  tolerated,  they  ought  certainly  to  be  watched  with 
a  jealous  eye.  The  establishment  of  asylums,  in  va- 
rious central  parts  of  a  country,  exclusively  appro- 
priated to  this  purpose,  under  the  particular  superin- 
tendance  of  government,  and  open  to  the  watchful 
inspection  of  proper  commissioners,  together  with 
the  advice  and  care  of  able  physicians  and  humane 
keepers,  is  the  plan  which  is  open  to  the  least  objec- 
tion, and  is  one  which  promises  the  happiest  results 
as  to  the  recovery  and  restoration  of  the  insane  to 
society*. 

*  Much  interesting  information  on  this  subject  will  be 
found  in  the  Report  of  the  Committee  of  the  house  of  Com- 
mons, and  Prof.  Duncan's  paper  on  the  State  of  Lunatics  in 
Great-Britain,  in  Edin.  Med.  8c  Surg.  Journal,  vol.  4.  p.  129, 
and  144, 


APPENDIX. 

THE  following  account  of   Lunatic  Asylums  in  Europe 
and  America,  may  probably  be  interesting  to  the  reader. 
ENGLAND. 
THE  largest  establishments  in   England  which  are  appro- 
priated to  the  confinement  of  Lunatics  are,  St.  Luke's  and 
JBethlem  Hospitals  in  London. 

St.  Luke's  Hospital.  This  institution  was  founded  in  1732, 
and  opened  in  1737.  It  then  admitted  1 10  patients.  On  account 
of  the  increasing  number  of  applicants,  a  new  building,  larger, 
and  more  commodious,  was  erected,  in  1787,  which  accommo- 
dates 300  patients,  divided  into  two  lists  or  classes  ;  200  on  the 
curable,  and  100  on  the  incurable  list.  The  latter  are  received 
according  to  the  order  in  which  they  have  been  discharged  as 
uncured  from  the  Hospital.  Of  these  there  are  at  present 
(1810)  more  than  600  waiting  for  admission.  Idiots  are  not  ad- 
mitted. Among  its  officers  are,  the  Duke  of  Leeds  Presi- 
dent, and  Dr.  S.  F.  Simmons,  Physician.  The  patients  ad- 
mitted from  July  30,  175  1,  to  April  21,  1809,  amount  to  9042, 
of  which  those  discharged  as  incurable,  and  received  again, 
amount  to  323.     Of  these, 

Patients  remaining,  April  21st.  1809,        ...         199 

discharged  cured,        -----       3915 

uncured,  -         -         -         -       3101 

as  idiots,  -         -  -         783 

dead,  -  748 

taken  away  by  friends,  and  discharged  from 

various  causes,         -         -         -         -         -         296 


Patients  received  the  second  time,  and  remaining  in 

the  house,      -         -         -          -         -          -  100 

taken  away  by  friends,          -         -         -         -  56 

dead, 145 

cured,         -------  \q 

discharged  from  various  causes,            -  4 

J23 
Mr.  Dunstan,  Master  of  St.  Luke's  Hospital,  states,  in  his 
examination  before   the   Committee  of  the  House   of  Com- 
mons, that  the  average  number  of  curable  patients  admitted 
annually  are,  and  those  discharged  are, 

Males        Femalea        Total 
Males,       W>  Cured,  37  71  108 

Females*  153  Uncured,  100 

Unfit  from  various  causes,  28 

20*3  Dead,  27 


36 


56 

From  the  above,  it  appears,  that  the  proportion  of  males  to 
females  admitted,  is  nearly  as  2  to  3  j  of  females  cured  to 
males,  nearly  as  2  to  1*. 

Bethlem  Hospital,  (commonly  called  Bedlam,)  was  appro- 
priated by  Henry  VIII.  to  the  reception  of  lunatics,  in  1547, 
at  the  suppression  of  monasteries.  The  present  building  was 
completed  in  1676.  It  can  contain  170  curable  patients  on 
an  average  Of  incurables,  it  receives  100  ;  fifty  of  each  sex. 
A  new  hospital  is  about  building.  The  improper  practice  of 
allowing  admission  to  visitors,  has  been  strictly  forbidden  and 
prevented  since  the  year  1770.  Physician,  Dr.  Thomas 
Munro. 

Report  of  Patients  in  Bethlem  Hospital,  Dec.  31,  1809. 
Remaining,  Dec.  31,  1808,       -         -  -  147 

Admitted  in  1809,  -  -         -         -         -  103 


250 


Cured  and  discharged,     ■ 

Died,      - 

Patients,  Dec.  31,  1309, 


Of  these,  men  under  cure,     -         -        *         -  39 

Incurable,      -         -         -         -         -  38 

Women  under  cure,     -         -         -         -         -  21 

Incurable,     -----  45 


250 

77 

66 
143| 


Mr.  Haslam  states,  that  from  1748,  to  1794,  forty-six  years, 
there  have  been  admitted  into  Bethlem  Hospital,  4832  wo- 
men, and  4042  men.  Of  the  women,  1 402  have  been  dis- 
charged cured  ;  and  of  the  men,  1155.  The  following  is  a 
statement  of  the  difference  of  age  in  the  patients  admitted, 
from   1784  to  1794,  ten  years. 


*  Highmore  on  the  Public  Charities  of  London,  p.  172. ;  and  Ed.  M .  &  S, 
J.  vol.  4.  p.  138. 
f  Highmore,  p.  13.  et  Seq.  &  Literary  Panorama,  vol,  8.  p.  870. 


37 


Age  between 

!0 

Sc 

20 

20 

Sc 

30 

30 

8c 

40 

40 

Sc 

50 

50 

Sc 

60 

60 

Ec 

70 

No.  discharged     No.  discharged 
cured.  uncured. 


Several  other  asylums  and  mad-houses  are  established  in 
different  parts  of  England.  A  system  of  reform  on  this 
point,  and  the  erection  of  hospitals  in  various  central  parts  of 
the  kingdom,  has  been  proposed  by  the  Committee  of  the 
House  of  Commons,  and  it  is  hoped  will  be  adopted.  Ac- 
cording to  their  Report,  it  appears  that  there  were,  in  July 
1807,  thirty-seven  lunatics  confined  in  different  jails ;  187S 
in  houses  of  correction,  poor-houses,  Sec. ;  and  483  in  private 
custody ;  besides  about  600  in  the  public  hospitals  of  Lon- 
don ;  making  nearly  3000  in  England  alone.  The  real  num- 
ber, however,  is  much  greaterf.  In  Scotland  and  Ireland,  no 
public  provision  has  yet  been  made  for  them. 


FRANCE. 

Asylum  De  Bicetre.  This  hospital  admits  200  patients. 
Of  these  the  idiots  constitute  always  one-fourth,  if  not  more. 
At  my  last  survey,  says  Mr.  Pinel,  there  were  27  melancho- 
lies, 95  maniacs,  18  affected  with  dementia,  and  60  idiots. 


*  Hailam.p.  2*5— 2-i'J. 

j  Literary    Panorama,  vol.  2.  p.   1259. ;  and  Dr.  Willan's  Reports  on  (lie 
Diseases  of  Loudon.     Hfl  estimates  Qie  lunatics  in  and  uear London  alone,  nl 
WO  thousand. 


38 


r  Maniacs  admitted|from  1784  to  1794,  inclusive,  with  their 
respective  ages. 


In  1784 
1785 
1786 
1787 
1788 
1789 
1790 
1791 
1792 
1793 
1794 


Total. 


Between 
10  &  20 

20&30 

5 

33 

4 

39 

4 

35 

12 

39 

9 

43 

6 

38 

6 

28 

9 

2© 

6 

26 

1 

.     13 

3 

23 

65 

339 

30&40 


31 
49 
40 
41 
53 
39 
34 
32 
33 
13 
15 


380 


40&50 

24 
25 
32 
26 
21 
33. 
19 
16 
18 
7 
15 

236 


50&60 

60&70 

6 

li 

14 

3 

15 

5 

17 

7 

18 

7 

14 

2 

9 

7 

7 

3 

12 

3 

4 

2 

9 

6 

130 

51 

Total. 

110 

134 

127 

142 

151 

132 

103 

93 

98 

40 

71 

1201 


The  deaths  in  1784,  were  fifty-seven:  and  in  1788  were 
ninety-five.  In  1794,  when  the  allowance  of  bread  had  been 
raised,  they  were  only  twenty -seven*. 

Asylum  De  Charenton.  During  twenty -two  months,  97  pa- 
tients were  admitted;  and  of  these  14  died,  and  33  were 
cured.  Out  of  71  cases,  whose  causes  could  be  ascertained, 
5  arose  from  excessive  pleasure,  7  from  disappointed  love, 
31  from  domestic  misfortunes,  1  from  terror,  2  from  sup- 
pressed discharges,  1  from  excessive  evacuations,  and  5  from 
hereditary  predisposition.     Physician,  Dr.  Gastaldif. 

Asylum  La  Sdlfietriere.  Dr.  Pinel,  in  less  than  four  years, 
cured  444,  out  of  8  i  4  maniacs,  confined  in  this  hospital.  Of 
36  struck  with  accidental  madness,  29  recovered!. 

AUSTRIA. 

The  general  hospital  at  Vienna,  was  founded  by  Joseph 
II.  and  consists  of  1 1 1  rooms.  To  it  is  attached  a  Lunatic 
Asylum,  of  three  stories  high,  each  28  rooms.  The  shape  of 
the  latter  is  that  of  a  perfectly  round  tower,  but  the  elevation 
was  probably  more  to  gratify  the  Emperor's  whim,  than  from 
any  particular  advantage  resulting  from  such  a  structure. 


*  Pinel  on  Insanity,  p.  32. 112.  173.  &  210. 

|  Pinel,  p.  249. 

•$  Med.  Repository,  vol.  12.  p.  294. 


39 


Remaining  at  the  end  of  1804, 
Admitted  in  1805,    - 


Males. 

Females, 

170 

144 

117 

94 

287  238 


Discharged,      -----         1G4  70 

Died, 42  32 

Remaining  at  the  end  of  1 805,  -         141  136 


287  238 


The  proportion  of  males  to  females  would  probably  be 
greater,  were  it  not  for  the  circumstance  of  the  Ecclesiastics 
having  an  asylum  for  lunatics  of  their  own  order*. 

PRUSSIA. 

The  principal  hospital  for  the  reception  of  the  sick  poor 
at  Berlin,  is  called,  "  La  Maison  de  Charite."  It  is  a  large 
building,  three  stories  high,  containing  about  1200  beds,  for 
three  classes  of  patients,  who  are  separated  into  three  divi- 
sions. 1.  Medical  and  surgical  cases.  2.  Lunatics.  3.  Ly- 
ing-in women,  and  their  children.  The  clebrated  Hufeland 
is  superintendant  of  the  Hospital.  The  following  is  the 
number  of  cases  during  four  years. 

1801  1802  1803  1804 

Mental  derangement,  179  200  238  200 

Under  this  head  is  placed  all  patients  affected  with  mania, 
melancholia,  and  fatuitas.  The  proportion  of  men  to  wo- 
men is  as  104  to  56.  Out  of  334  cases,  105  were  cured  ;  and 
the  cure  is  said  to  be  owing  to  the  external  application  of  cold 
waterf. 

SPAIN. 

According  to  the  Rev.  Mr.  Townscnd,  the  government 
returns  of  that  country  for  1787,  gave  the  following  list  of  lu- 
natics in  confinement,  in  the  different  provinces. — 
Arragon,  244.  Valencia,  12  1.  Granada,  41.  Leon,  2. 
Catalonia,  114.  Andalusia,  99.  Toledo,  42.  Avila,  1. 
No  mention  is  made  of  any  in  the  interior  provinces}. 

SWITZERLAND. 

There  are  five  hospitals  in  and  near  Bern,  one  of  which  is 
hi  asylum  for  lunatics.     Nervous  diseases  arc  very  common 

intiy,  i.nd  ilie  proportional  number  oi 

Bdk    M  I,  roi  2.  p.  M  I  |  Bdin.  If,  It  B.  J.  voL£  p.  370 

•  ;'»  Travail  in  Spain,  rot  2.  i>.  jsi 


40 


epileptic  and  lunatic  patients  is  much  greater.  Upwards  of 
60  were  confined  in  this  asylum,  in  Aug.  1805,  all  in  separate 
cells,  and  almost  all  of  them  had  dark  hair  and  eyes  ;  and  were 
melancholic*. 

NEW-YORK  HOSPITAL  AND  ASYLUM. 

Until  the  year  1808,  the  insane  have  been  confined  in  the 
New-York  Hospital.  It  is  stated,  on  the  authority  of  Dr. 
Hosack,  that  during  a  practice  of  ten  years,  as  one  of  the 
physicians  of  that  Institution,  he  found  the  disease  to  have 
arisen,  in  the  greatest  number  of  cases,  from  intemperance  ; 
and  that  in  such,  the  antiphlogistic  treatment  was  found  high- 
ly useful.  The  lunatic  asylum  was  opened  on  the  1 5th  July, 
1808.  It  contains  sixty-four  rooms,  and  can  accommodate 
about  70  patients.  Physician,  Archibald  Bruce,  M.  D.  As 
there  has  been  but  one  separate  Report  of  this  establishment, 
(for  i  8  i  0,)  it  has,  for  the  sake  of  convenience,  been  incor- 
porated with  those  of  the  hospital. 


1 

1 

Admitted. 

Discharged. 

1 

a. 

| 

<  O 

i 

a  W 

2  fl> 
I3 
"  §• 
■<•  5. 

%<* 
S?  o 

f| 

V!  ft 

o 

e 

i 

3-" 

P  & 

si5 

P-3 
3* 

I 

- 

•'3 

1 

*?r 

1804  | 

11 

46 

22 

5 

12 

3 

15 

1805 

15 

60 

30 

4 

13 

8 

20 

1806 

20 

68 

29 

31 

7 

21 

1S07 

21 

47 

18 

3 

19 

4 

24 

1S08 

24 

66 

16 

10 

16 

4 

44 

1809  1 

44 

80 

22 

4 

48 

8 

42 

1810  1 

43 

90 

44 

7 

16 

10 

56 

1 

178 

457 

181 

33 

155 

44 

222 

Of  133  in  the  asylum,  in  1810,  there  were 


Males. 
86 


Females. 
49 


Cured,  - 

Died, 

Discharged,  - 
Remaining,  Dec.  31,  1810, 


35 

n 

10 

34 

86 


& 
13 

24 

49 


The  ahove  Statement  is  obtained  from  authentic  documents,  and  partly 
through  the  politeness  of  Mr.  Green,  clerk  of  the  New- York  hospital. 

*  Edin.  M.  &  S.  Journal,  vol.  5.  p.  254. 

•}"  Of  these,  two  died  by  suicide,  and  one  a  few  hours  after  reception. 


FINIS. 


COLUMBIA  UNIVERSITY 

This   bqok  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

MkY  2 

3  IJlif 

C28(638)MS0 

B38 


